Payers & Providers California Edition – Issue of August 11, 2011

8/6/2019 Payers & Providers California Edition Issue of August 11, 2011

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Anthem Blue Cross of California will launchan accountable care organization in the heartof Silicon Valley in the fourth quarter of 2011,the second ACO initiative announced by a

major insurer in little more than a week.Blue Cross announcement on

Wednesday that it would team with thePractice Association Medical Group of SantaClara County, or SCCIPA, comes about aweek after San Francisco-based Blue Shield of California announced a similar alliance withSt. Joseph Health System in Orange County.

This is Blue Cross rst ACO in NorthernCalifornia. It entered into an ACOarrangement in Southern California lastMarch, partnering with two of Sharp

Healthcares medical groups in the San Diegoarea.

SCCIPA's investment in (a) coordinatedcare IT platform and demonstrated qualityclinical and administrative managementperformance...make them an ideal partner tooffer our rst ACO model in northernCalifornia, said Blue Cross President PamKehaly.

SCIPPA also has a deep reserve of clinicians. Its 284 primary care physicians,550 specialists and contracts with 10 hospitalsmade it an attractive ACO partner, accordingto Blue Cross of cials.

The Blue Cross-SCCIPA arrangement isexpected to cover as many as 25,000 lives in

the Silicon Valley and other areas immediatelysouth of San Francisco, of cials said abouthalf of those Blue Cross enrollees who receivetheir physician care via SCCIPA. Enrollmentwill be purely voluntary. It was not yetdetermined what payments would be bundledfor speci c services, nor were cost savingsprojections released.

The Blue Shield ACO also its second inCalifornia will involve about 30,000enrollees who receive care through St.

Josephs three hospitals and six physicianorganizations in Orange County. It will launchin January 2012.

"We're excited about the potential for thiscollaboration to advance our mission todeliver care that is safe, timely, evidence-based and ef cient, while enhancing thepatient experience, said St. Joseph Chief Executive Of cer C.R. Burke.

Blue Shield currently has an ACO pilotproject in operation with Hill Physicians Group and Catholic Healthcare West in theSacramento area, focused on improving thecare of about 38,000 retirees enrolled in theCalPERS system.

That ACO has been a success to date. Asof late 2010, the collaboration reported a 4%reduction in hospital admissions, a 9% drop inthe average length of a hospital stay, and a24% reduction in hospital readmissions within30 days of discharge.

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Payers & Providers Page 2

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In Brief

Kaiser Pledges $10MTo Fight Obesity

Oakland-based Kaiser Permanentehas pledged up to $10 million to

combat obesity in NorthernCalifornia.The money, in $1 million grants,

will be given to seven communities inthe region San Francisco, Modesto,Madera, South Sacramento, SantaRosa, Concord and Richmond. It willbe used to extend Kaisers HealthyEating Active Living (HEAL) zoneswhere biking, eating fresh produceand participating in after-schoolsprograms are encouraged and maderoutine.

Kaisers original HEAL initiativewas scheduled to end this year, butwill be continued with the newgrants. These speci c HEAL zones will

be developed over the next threeyears."In the rst ve years of the

HEAL work, we saw increasedphysical activity, greater availability of healthy food in corner stores,improvement of our local parks andcreation of safe walkways. We alsolearned that going forward, we couldmake a greater impact byconcentrating our efforts in smaller,more targeted areas, said YvetteRadford, Kaiser Permanentes regionalvice president, External andCommunity Affairs, NorthernCalifornia.

In addition to the grants, Kaiser

will pledge an additional $3 milliontoward technical and evaluationsupport.

O.C. Physician PleadsGuilty To Fraud

A Cerritos physician pleaded guiltyearlier this week to 40 counts of fraudin Orange County Superior Court.

Continued on Page 3

NEWS

Public Citizen Slams Medical BoardClaims Enforcement Actions Have Plummeted

The consumer advocacy group Public Citizen has excoriated the California Medical Board for failing to discipline physicians who areengaged in acts that are endangering patients.

According to the Washington-based PublicCitizen, the Medical Board failed to discipline710 physicians who between 1990 and 2009who had been disciplined or cited byhospitals, ambulatory surgical centers andhealth plans for negligent acts that put patientsin harms way.

The sanctions taken against the largemajority of this group were severe: 447, or63%, had their privileges permanently

restricted or denied outright for a year or more.Thirty- ve percent of physicians who werenot disciplined by the Medical Board receivedsanctions or penalties from another body thatgoverns physicians. An equal percentage werecited more than once by hospitals or otherpayers or providers for delivering substandardor dangerous care.

Unless the California Medical Boardsigni cantly improves its record of failing todiscipline those California physicianspreviously found by their hospitals or otherplaces they practice to present an immediatethreat to health or safety, tens of thousands of California patients are at risk of being injuredor killed by these doctors, said Sidney Wolfe ,M.D., director of Public Citizens HealthResearch Group.

Public Citizen studied 19 years worth of data from the National Practitioner Database ,and concluded that 5,887 doctors hadreceived some form of sanction from aprovider or payer organization, but none froma state licensing board. During that same timeperiod, 220 physicians had been deemed bypeer reviewers as an immediate threat to

health or safety of patients. Of those, 102were practicing in California.In a letter Public Citizen sent to Gov. Jer

Brown this week asking for intervention, itdescribed the Medical Board as delinquent.The letter also cited the negligence ormisconduct of several California physicians(whose names were concealed by the NPDB).

In one instance, a physician had threeclinical actions taken against their privileges,and had eight medical malpractice payoutsbetween 1991 and 2008 totaling about $2million. Another physician had seven clinicalactions taken between 2002 and 2009, three

of which led to the permanent suspension of privileges.The Medical Board did not immediately

respond to a request seeking comment.According to a report earlier this week in theLos Angeles Times , the agency cited budgetcuts and a hiring freeze as among the reasonsit is lagging in disciplining doctors, but saidmore analysis would be needed before itcould concur with Public Citizens ndings.

In correspondence with Public Citizenfrom March, the Medical Board claimed thatbudget cuts would make it dif cult to followup on the 710 physicians who escaped itsdiscipline.

Public Citizens analysis tends to con rma regulatory agency whose potency has wanedin recent years, particularly since the onset of the Great Recession in late 2007, which led todraconian budget cuts in California.

In 2006, the Medical Board was amongthe top half of the state medical boards interms of disciplining physicians. In 2010, itwas 41st. It ranks 35th in 2011. In 1997,during far usher economic times, it ranked18th in the nation.

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Page 3Payers & Providers

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NEWS

In Brief

Michael C. Chan , 65, faces up to28 years in prison for the charges,which arose from his performingunnecessary surgeries on patients whowere recruited by cappers. Thepatients were paid several hundreddollars to undergo unneededcolonoscopies and xes to sweatypalms. Chan performed them at theUnity Outpatient Surgery Center inBuena Park, which is now closed. Hewas accused along with three otherphysicians in the scheme.

In addition to facing prison time,Chan was ordered to pay $250,000 inrestitution. The cost of the fraud isestimated at $154 million.

"Let this conviction stand as awarning to those who think they willnot be brought to justice," saidCalifornia Insurance CommissionerDave Jones .

Chan and his colleagues werethe target of a joint investigation by

Jones of ce and the Orange CountyDistrict Attorney.

DMHC IMR ProcessMeets Reform

Standards

The U.S. Department of Health andHuman Service s has certi ed that theindependent medical review processoperated by the CaliforniaDepartment of Managed Health Care meets all the standards of the PatientProtection and Affordable Care Act.

The DMHC adopted its IMRprocess in 2000. It allows enrollees inCalifornias health maintenanceorganizations to le grievances if carehas been denied, and allows theDMHC to make a separate bindingruling as to its medical necessity.

Under federal healthcare reform,health plan consumers are entitled toinformation as to why a claim or careis denied, and are entitled to anappeals process.

We were con dent thatCalifornias IMR process...would meetfederal standards and not require anyadditional legislative changes, saidDMHC Interim Director Edward G.Heidig.

Health Plans Report Strong EarningsKaiser, Health Net Say Quarterly Numbers Are Up

of ce buildings in California over the pastve years.

Woodland Hills-based Health Net reported net income of $58.3 million for thesecond quarter, up 30% from $45 million forthe year-ago quarter. Revenues were $2.8billion, compared to $3.4 billion in thesecond quarter of 2010, a decline of 19.2%.Company of cials said the change of a largeTRICARE contract to administrative servicesonly is to blame.

Nonetheless, the insurer bumpedearnings guidance up modestly for theremainder of the year.

Membership in our tailored networkproducts grew, commercial marginsexpanded and the transition to the newTRICARE contract went smoothly, saidHealth Net CEO Jay Gellert .

Overall enrollment in Health Net plansdipped about 2.2% from the second quarterof 2010, to 3 million from 3.1 million.

Two powerhouse health entities in Californiasay their second quarter earnings were upsigni cantly. It suggests that, for the moment,the nancial hits from the Great Recession arereceding into the past.

Oakland-based Kaiser Permanente reported net income of $663 million for thequarter ending June 30, up 64% from the $404million reported in the second quarter of 2010.Revenue was up 9%, to $11.9 billion from $11billion. Enrollee growth since the start of 2011is 208,000, or about 2.5%.

"Our operating results, coupled with asound investment strategy, enable us to reinvestin health care facilities, technology andprograms that are essential in continuing tomeet the needs of our members, said KaiserChief Financial Of cer Kathy Lancaster .

Kaiser spent $735 million on capitalspending during the quarter, up 227% from thesecond quarter of 2010. It has constructed 13new or replacement hospitals and 86 medical

Junk Food Ghettos A Teen Risk UCLA Study Links Proximity To Declining Diets

A new study by UCLA researchers concludesthat there is a strong correlation between thepresence of fast food and junk food outlets inneighborhoods and higher rates of theirconsumption by adolescents.

Authors of the study, which wasconducted by the UCLA Center for HealthPolicy Research , formulated what it calls theHome and School Retail Food EnvironmentIndex. It is reached by dividing the number of a neighborhoods convenience and liquorstores by its grocery stores and producevendors within the radius of schools andhomes. The statewide average index is 7.9,meaning there are nearly as eight times asmuch access to fast food and junk food thanthere is to supermarkets and other sources of fresh food and produce

If you live in a place where there's a fastfood restaurant or convenience store on everyblock, with few healthier alternatives, you arelikely to eat more junk," said Susan Babey, asenior UCLA research scientist and one of thestudys co-authors.

The indices varied by region. The ruralNorthern California counties had an index of

5.2, the Central Coast at 5.5. and the Bay Areat 7.3. However, the Sacramento area was at9.3, while the Los Angeles area is at 8.5.

The county with the lowest index isHumboldt, with a 3.1 score. Sutter Countyhad the highest index, at 10.3.

Adolescents living in areas with a higherindex were 17% more likely to drink sugarydrinks such as soda every day, and 18% morelikely to consume fast food twice a week ormore.

Studies have linked higher rates of fastfood and sugary drink consumption to obesityand chronic health conditions such as typetwo diabetes.

"It is a travesty that our kids have betteraccess to liquor stores and other unhealthyfood outlets than a grocery store," said RobeK. Ross, M.D., chief executive of cer of theLos Angeles-based California Endowment ,which funded the research. "We have put ourchildren and youth in harm's way, and theyare paying the price for our carelessness. If nothing is done, this will be the rstgeneration to live shorter lives than theirparents."


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Payers & Providers Page 4

Accountable care organization (or ACO). Youneed to go back 30 years to DRG (followedquickly by PPO and HMO) to nd a three-letteracronym that has ignited as much buzz. Atpresent only a handful of trial accountablecare organizations have emerged, yet wealready know three irrefutable truths.

The rst is that ACOs will elevatecompetition to a level many communities havenever seen. Thats because as hospitals work toalign themselves with physicians, theircompetitors are doing the same. More thanever, winners and losers will emerge,

necessitating hospitals to be moreaggressive, more strategic and moreopen than ever before to takingcalculated risk.

A second truth is that ACOs arelikely to spawn a new era of costshifting. This concept is not new tohealthcare; those who could payhave always fronted the burden forthose who couldnt. But as hospitalsbecome accountable for the care of an entire community, it will beeven more important to have astrategy in place to attract

favorability insured consumers. That brings usto the most important truth of all.ACOs are about relationships. Looking at

the nations most successful integratedhealthcare systems Geisinger, Inova Health,Kaiser it is clear that for ACOs to succeed,hospitals and physicians must align theirincentives and establish a relationship built ontrust one where win-win becomes morethan a clich.While many hospitals alreadyhave a physician relationship managementprogram in place, few are achieving signi cantimpact. That is because instead of seekingopportunities for strategic alignment and

ongoing engagement, these programs are oftenbuilt around outdated meet-and-greetactivities or simply address quick xes such asmore convenient block times in the operatingroom.

According to a survey by the AmericanCollege of Physician Executives, only 16percent of ACPE members rated the relationshipbetween hospitals and PCPs as doing well.That is a frightening and untenable statistic.One of the most effective ways to bridge thisgap, according to the ACPE survey, is to

implement a formal physician relationshipmanagement program.

When optimally planned and executed, suca program can create three critically-importantalignments.

Referral Alignment By working with PCuncover barriers and help foster connections wispecialists, hospitals can facilitate a steadierof patients. Referral alignment also helps identichallenges physicians may be having withaccessing and delivering services at the hospita

Strategic Alignment - While most hospitalhave a loyal group of admitting

physicians, often the majority aresplitting referrals between severhospitals. There are also likelyphysicians in the community whohave chosen not to join the medicastaff at all. Strategic alignment heleducate physicians about the beneof associating with the hospital andinvites them to be part of thedecision-making process, which catranslate into increased personal an

professional satisfaction.Economic Alignment - L

hospitals, most physicians hav

seen their income decrease as reimbursementdeclines. Many doctors are looking for new wayto grow their income, such as through jointventures or adding new services. Hospitals canhelp identify gaps in services within thecommunity and, where appropriate andallowable, partner with physicians to ll thosevoids and foster market share growth.

Today, more than ever, hospitals need toenact a physician relationship managementprogram that identi es potential growth marketargets physicians most likely to drive newreferrals, and addresses a physicians core needsand professional goals. Only through this data-

driven approach can hospitals and physiciansachieve the kind of competitive advantage needto win in the world of ACOs.

OPINION

Getting Past The Initial Buzz On ACOsRelationships Will Differentiate What Works And Fails

By Pearson Talbert

Pearson Talbert is the president of AegisHealth Group, a hospital consulting firm inBrentwood, Tenn.

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MARKETPLACE/EMPLOYMENTPayers & Providers Page 5

Keenan & Associates is a successful insurance brokerage and consulting firm meeting the insurance needs of hospitals, publicentities and California school districts. Keenan specializes in providing consulting services in the areas of: Employee benefits,Workers' Compensation, Loss Control, Financial, and Property & Liability. We have seen continuous progress and expansion,making us the 18th largest consulting firm in the United States. This growth positions us to continue to lead the industry into the21st century.

We currently have two exciting career opportunities in our Torrance, CA headquarters, supporting our Healthcare TPA:

NURSE CASE MANAGERWill identify, implement, and provide oversight of employer group populations in order to optimize Blue Cross Medical Management programs and/or strategies. Itwill include case management oversight of the Utilization Management, Care Coordination, Disease Management, Case Management, and Transition of Careprograms.Essential responsibilities include: Implement and utilize protocols, criteria, guidelines, references, and resources to determine if current medical delivery of services is effective and optimal. Evaluate current reporting capabilities and data feeds provided by carrier in order to triage and isolate employee populations that may not be optimizing their

current Medical Management Services. Develop Case Management Plan. Gather information and coordinate multiple medical services . Validate current plan of care or changes through ongoing monitoring and gathering of information. Perform oversight of the medical care delivery systems. Monitor expediency of services. Benchmark appropriate patient recovery against community standards and evaluation tools which are utilized by the carrier Medical Management Teams/

Product Unit Managers. Assess patients recovery and progress by frequent monitoring and interface with the Blue Cross Management Staff. This will involve review and evaluation of

coordination of Home Care Services, Durable Medical Equipment, Pharmaceutical Services, and other auxiliary rehab/medical services. Communicate collaboratively. Nurture healthy and effective communications. Oversee appropriate correspondence in relation to the case management and utilization review process. Assess the individuals psychosocial status via frequent contact and relationship building. Divert barriers to recovery and progression via frequent conference

and collaboration with the patient as well as the patients support system. Document decisions, rationale, and resources regarding cases by maintaining on-line Nurse Case Management Software Systems and other applications.

Minimum Suggested Qualifications: Requires clinical expertise, especially in assessing chronic care needs and service coordination. Registered Nurse with acurrent, active, and unrestricted California license. Prefer graduates of an accredited school of Nursing (Associates Degree at minimum: BSN is preferred) andCCM. Advanced degree in Business Administration, Healthcare Administration, or IT highly desirable.. Must possess theoretical knowledge base of nursingprocess, clinical pathways, continuum of care, and case management methods & standards. Must be versed in Nursing Theories and Models of RecoveryOrem, Watson, Roy) Must be comfortable with IT applications and should be able to interpret and identify claims trending data.

MANAGER, CLAIMS AND CUSTOMER SERVICEWill be responsible for the Healthcare TPA departmental budgeting, procedures, production goals, quality standards, service metrics and personnel managementof the Claims, Customer Service, Provider Relations, Clerical Support and Adjustment teams.Essential responsibilities include: Provide benefit claims team with technical direction and resources to achieve efficient benefit claims handling at efficient cost level while maintaining a highevel of customer service. Responsible for the development and implementation of the best claims practices which will result in operational excellence. Specifically, the claims team will

achieve quantitative and qualitative performance expectations, meet customer expectations as outlined in client service plans, and achieve high ratings incustomer feedback surveys. Continuously review all performance standards and measurements to ensure appropriateness and provide tracking and reporting of results against all

measurements to facilitate improvement in customer service and productivity. Accountable for developing and mentoring team members. Manage coaching and skill building to strengthen the technical and professional level of the team. Responsible for quality assurance and audits of customer service representatives through either silent call monitoring or implementation of a call recording

program. Responsible for meeting claim adjudication quality and processing turnaround in conformance with industry standards. Conduct customer satisfaction interface/surveys and disseminate findings to management. Develop plan to address areas of improvement.

Minimum Suggested Qualifications: Bachelors Degree or equivalent experience. Management, benefits administration and claims adjudication experiencenecessary. Must have strong understanding of all aspects of self-funded healthcare claims. Five plus years as a manager in a similar industry, environment..Experienced at monitoring and maintaining production goals. Must be proficient in Microsoft Word. Excel knowledge preferred, but not mandatory. Adept ataccessing data from the Internet when required.Keenan provides a competitive compensation and benefits package. We encourage teamwork and employee initiative - people working together is what makesKeenan a success. We invite you to share in the commitment of preserving our warm tradition, reputation and dedication to our clients. After allWhat you domakes a difference!

Please submit your resume and salary history to Beth Cross at [email protected] . For more information, visit our website atwww.keenan.com . Keenan is an equal opportunity/affirmative action employer and supports workplace diversity.


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Payers & Providers MARKETPLACE/EMPLOYMENT Page 6

HEALTH PLAN MEDICAL DIRECTOR (Southern California)

Physician licensed by the State of California, with board certi cation in primary care or medical subspecialty. Haveve (5) years of Medical Director experience in a managed care setting, such as a HMO or IPA/Medical Group.

Medical oversight and physician liaison in the areas of: Utilization Review, Credentialing, Quality Improvement, PeerReview, Case Management, and Disease Management.

Works under the direction of the Chief Medical Of cer to ensure the delivery of high quality and ef cient care for allmembers. Provide administrative management of patient care with speci c responsibility to provide direction andassistance in achieving optimal medical performance in an ef cient manner. To participate and lead in the review of all inpatient admissions. Direct and review all inpatient utilization activity at hospitals by interfacing with theclinicians and utilization review nurses. Oversee the review process of prior authorization (medical and pharmacy)requests in a timely manner. All denials must be individually reviewed and signed by the Medical Director orphysician reviewer.

HEALTH PLAN NATIONAL DIRECTOR OF QUALITY & ACCREDITATION (Southern California)Under the supervision of the Associate Chief of Managed Care, the National Director of Quality and Accreditation isresponsible for the agency wide quality improvement program and its outcomes.

Essential Duties and Responsibilities:

Ensures the QI programs in California and Florida meet contractual, regulatory and accreditation standards. Trains, develops and mentors the Quality staff in California and Florida to ensure QI program objectives are met. Sets an example for the Leadership team in terms of quality initiatives and quality process to achieve organizationalgoals. Supports compliance with AAAHC accreditation standards and NCQA standards, where applicable. Assists with preparation of HEDIS data collection, validation audits and data submission.

Ensures HEDIS results are used to establish clinical and quality improvement projects to improve memberoutcomes. Works collaboratively with Leadership team to prepare for audits and surveys Support the effort to complete the annual Member Satisfaction and Provider Satisfaction surveys and ensure resultsare incorporated into the QI Program. Collaborates with MIS and QI Data Analyst to ensure data is presented and used ef ciently to meet the needs of theQI Program. Ensures the annual Quality Program and Work Plan are documented, approved and contents implemented. Ensures all contract requirements are represented by quality monitors that are documented, reviewed and supportcompliance to contractual quality standards. Assist staff, as needed, in the investigation, documentation and resolution of grievances and appeals to contributeto member satisfaction, quality outcomes and required regulatory reporting. Ensure Medicaid and Medicare regulations and standards are included and well managed in the QI Program.

Education and/or Experience:Bachelors degree in a healthcare related led from a four-year college or university Preferred Masters in PublicHealth (MPH) and/or Masters in Business Administration (MBA) and/or Masters in Health Administration (MHA)PleaseContact:

Executive Search & PlacementSonia Varian - 818-707-7118,

or [email protected]


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Payers & Providers California Edition – Issue of August 11, 2011

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